Iswar Sankalpa 24
1. Problem Statement
According to the government, “Houseless Households” refer to families who do not live in ‘census houses’/ homes with a roof, and are found on roads, pavements, under the flyovers, railway platforms and the like. Between the two censuses in 2001 and 2011, the numbers of these houseless households in urban India showed 37% growth (from 1.87 lakh to 2.56 lakh). This is majorly due to the unavailability of the various social schemes; most of which are meant for the ones in the rural areas. During the same period, West Bengal recorded an increase in the number of homeless households by 48% (from 19,385 to 28,647).
Sabuj (2014) in his study on the Homeless people of Kolkata, elaborates that, out of the 141 Kolkata Municipal Corporation wards, homeless people were found in 118 wards. These people had no safety (belongings got stolen), varied weather conditions made their life difficult, living conditions were
24 Contributed by Piyal Kothari
Figure 1: Ward maps indicating the coverage of our program
unhygienic and they were frequently evicted by the police or harassed and tortured by other community people.
Homelessness might lead to mental health issues or vice versa. They are two pervasive issues that societies need to urgently address, as both have a negative impact on the lives of individuals and communities (Kaur and Pathak, 2016). A couple of studies have been conducted to understand prevalence of mental illness in homeless population in developed and developing nations; one of them states that out of the 140 homeless persons admitted to the department of psychiatry of a North Indian medical university (Feb’05 - July’11), 90.7% were diagnosed with psychiatric illness and 55.7% had more than one psychiatric disorder. 84.3% of the total admitted25 experienced mental illness before leaving their home and 54.3% left home due to mental illness. After treatment, it was possible to reintegrate 70% of the patients into their families. No treatment or inadequate treatment for the mental illness
25 Psychiatric illness is interchangeably used with mental disorder/ mental illness – no difference (it is an umbrella term) Psychotic disorder are severe mental disorders
Figure 2: Community Caregiver model
was found to be one of the common causes for homelessness. Additionally, amongst the psychiatric illnesses in homeless persons with mental illness, 65% were found battling psychotic disorders, 44.3% were found to be in the grips of substance use and 12.9% were grappling with bipolar disorder/ mania (Tripathi et al., 2013).
In 2007, Iswar Sankalpa conducted a Baseline Survey of Homeless Persons with Mental Illness within the 141 wards of Kolkata. The survey, conducted over a period of 8 months, identified over 466 persons in need of immediate medical treatment and psycho-social support. The disorder profile of persons identified in the Baseline study is illustrated below in Figure 3:
Other findings include the following:
1. The majority of the people were 18-35 year.
2. 20% of cases had major physical ailments 3. 90% of the men had physical injuries
4. While women were the most vulnerable to sexual abuse and harassment, men were also subjected to physical abuse.
5. A large number, mainly men, were prone to substance addiction
There are about 400,000 wandering mentally ill persons in India. They are found battling mental distress and physical abuse especially in urban areas.
They hail from economically poor and socially marginalized sections of the Figure 3. Disorder profile pie chart
society. Nine out of the ten have diagnosable and treatable mental health conditions and four out of five have co -morbid physical health issues. This picture becomes all the more complex given the fact that India lacks adequate supply of mental health services and the ones that exist, are inaccessible in majority of the cases. Homeless persons with mental illness are a special population, for they need to be picked up from the streets to be taken to the hospital, they lack an identity, no past history is available either due to memory loss and/ absence of a familial support and most of them suffer from severe mental disorder calling for a rehabilitation either through reunion with respective families or establishment of shelter homes (Singh, Shah and Mehta, 2016).
Unemployment and poverty have also been found to be intrinsically connected to homelessness and mental illness. While there is no causal link between poverty and mental illness, the two states can feed into each other – while poverty and its attendant stressors are a breeding ground for mental disorders, untreated psychiatric disorders can lead individuals and families into unemployment, social alienation and poverty. Poverty, homelessness, mental illness coupled with physical health issues forms a grim picture of persons living on the streets for years.
Civil Society Organizations in this field are few like Health Initiative Group for the Homeless (a joint initiative by the Institute of Human Behavior and Allied Sciences, Aashray Adhikar Abhiyan, and Delhi State Legal Services Authority), Koshish (by Tata Institute of Social Sciences in Delhi and Mumbai), Adaikalam by Banyan in Chennai (Lancet, 2016). The National Report on the Status of Shelters for the Urban Homeless (2014) outlines that the number of permanent shelters for the urban homeless is woefully inadequate in India and the allied services are virtually absent in the shelters. The accommodation capacity is far below the normative stated by the Supreme Court and the National Scheme of Shelter for Urban Homeless. In Kolkata (West Bengal) against a need of 44 shelters, there exists only 29 permanent shelters for the urban homeless, out of which only 14 are operational. Government agencies at both state and national levels fail to take responsibility and have no policy or planning for Homeless persons with mental illness in particular.